Hasenbein U, Kuss O, Bäumer M, Schert C, Schneider H, Wallesch C W
Institute of Neurological and Neurosurgical Rehabilitation Research, Magdeburg, Germany.
Disabil Rehabil. 2003 Feb 4;25(3):136-42. doi: 10.1080/0963828021000024889.
Analysis of medical decisions in the differential allocation of traumatic brain injury (TBI) rehabilitation programmes.
Medical specialists routinely involved in the treatment and rehabilitation of TBI patients from acute hospitals, rehabilitation centres, and the Medical Services of the Workers' Pension Insurance of Sachsen-Anhalt and Mecklenburg-Vorpommern were included in a systematic survey, in which they had to give their opinions on the individually optimal rehabilitation setting and therapies and probable outcome on the basis of case vignettes. These specialists are crucial for decision-making in rehabilitation resource allocation.
Both allocation and prognosis depended mainly on patient characteristics. In a mixed logistic regression model, which takes into account that: (a) patient and physician characteristics may influence each other; and (b) that expert assessments might be correlated, setting preferences were related to chronicity and degree of motor and cognitive impairment, but also to the institutional background of the reviewer. Neuropsychological therapy dominated intervention recommendations, followed by physio- and occupational therapy. A comparatively great demand of psychotherapy and medicosocial assessment was recognized. Preferred rehabilitation setting did not influence the physicians' subjective prognosis. Older, chronic and motorically impaired patients were considered to profit less from rehabilitation. Physician characteristics and recommendations of either rehabilitation setting or therapies did not influence prognostic expectations.
Physician characteristics influenced setting preferences. Preferences for type of treatment and ADL-prognosis depended on patients' variables only. Expected effects of rehabilitation were independent on rehabilitation setting and kinds of treatment.
分析创伤性脑损伤（TBI）康复项目差异化分配中的医疗决策。
来自急性医院、康复中心以及萨克森 - 安哈尔特州和梅克伦堡 - 前波美拉尼亚州工人养老保险医疗服务部门的、日常参与TBI患者治疗与康复的医学专家被纳入一项系统调查，在调查中，他们必须根据病例 vignettes 对个体最优康复环境、治疗方法以及可能的结果发表意见。这些专家对于康复资源分配决策至关重要。
分配和预后主要取决于患者特征。在一个混合逻辑回归模型中，该模型考虑到：（a）患者和医生特征可能相互影响；（b）专家评估可能相关，康复环境偏好与慢性程度、运动和认知障碍程度有关，但也与评审者的机构背景有关。神经心理治疗在干预建议中占主导地位，其次是物理治疗和职业治疗。人们认识到对心理治疗和社会医学评估有相对较大的需求。首选的康复环境并未影响医生的主观预后。年龄较大、慢性且有运动障碍的患者被认为从康复中获益较少。医生特征以及康复环境或治疗方法的建议并未影响预后预期。
医生特征影响康复环境偏好。对治疗类型和日常生活活动预后的偏好仅取决于患者变量。康复的预期效果与康复环境和治疗种类无关。
